1. IVC TRAUMA
NORTHERN TRAUMA CONFERENCE 2014

2. IVC TRAUMA
Penetrating
Blunt
Non

3. IVC Trauma due to penetrating injury
High mortality (70%)
Higher if other associated vascular injuries
Recognised as a severe marker of injury
Consider other involved structures

4. IVC TRAUMA - Imaging
Range of injuries
Severity of injury
Difficulty of imaging - rate of blood loss and poor identification
Rare finding. They often die before reaching CT

5. IVC TRAUMA - IMAGING SIGNS
Index of suspicion. If you don't look for it, you won't find it.
Active bleeding on CT
Retro peritoneal haematoma
Adjacent organ injury or other injuries
Flat IVC
Direct/indirect. Two lists

6. IVC Injury – Imaging signs
DIRECT
Extravasation
Retroperitoneal haematoma
INDIRECT
Adjacent injuries
Pericaval oedema
Hypovolaemia

7. Hypovolaemia
Hypovolaemia with collapsed IVC/right heart (despite aggressive resuscitation)

8. Hypovolaemia
Hypovolaemia with collapsed IVC/right heart (despite aggressive resuscitation)

10. American Association for the Surgery of Trauma Organ Injury Scale for Vascular Injuries
OIS Grade*
Artery Injured
Vein Injured II
Hepatic Splenic Gastric Gastroduodenal Inferior mesenteric Primary named vessels of superior mesenteric
Splenic Inferior mesenteric
III
Renal Iliac Hypogastric
Superior mesenteric Renal Iliac Hypogastric Vena cava (infrarenal) IV
Superior mesenteric (trunk) Celiac axis Aorta (infrarenal
Vena cava (infrahepatic) V
Aorta (suprarenal)
Vena cava (suprahepatic) Vena cava (retrohepatic) Portal Hepatic (extrahepatic)

11. IVC Injury - Penetrating
24 year old male
0100 Stabbed in back
0230 Arrived in TU ED
0500 CT scan
0730 Laparotomy
1000 Transfer to Cardiothoracic Surgery

12. IVC Injury - Penetrating

13. IVC Injury - Penetrating

14. IVC Injury

15. IVC Injury - Blunt 22 year old male
RTC – two vehicle head on collision. Driver of vehicle
Direct to MTC

16. IVC Injury - Blunt 22 year old male
RTC – two vehicle head on collision. Driver of vehicle
Direct to MTC
Injuries include
Left hepatic contusion
Ruptured left hemidiaphragm

17. IVC Injury - Blunt 22 year old male
RTC – two vehicle head on collision. Driver of vehicle
Direct to MTC
Injuries include
Left hepatic contusion
Ruptured left hemidiaphragm

18. IVC injury – blunt trauma

19. IVC injury – blunt trauma

20. IVC Injury - Blunt 22 year old male
RTC – two vehicle head on collision. Driver of vehicle
Direct to MTC
Injuries include
Left hepatic contusion
Ruptured left hemidiaphragm
Retroperitoneal haematoma 2ary to IVC laceration

21. IVC Injury - Blunt Repaired surgically (along with other injuries)
Good recovery

22. IVC TRAUMA - SUMMARY
Marker of v severe injury
Rarely reaches imaging
Awareness of potential allows recognition
Underestimation of depth of penetration in penetrating injury
Underestimation of haemorrhage in penetrating injury